CAMP MEETING: JULY 18, 2024 - JULY 28, 2024
CAMP SYCHAR
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We are so excited that you will be joining us for these 10 exciting and life changing days! Please make sure that you complete all portions of the application. Before you complete the registration below please make sure you have read the two documents on the previous page!
Camp fee is $110 for all campers.
Please plan to make payment when youth check-in at camp. Payment can also be mailed to the Youth Program mailing address. Please note any mailed payments will not be processed until camp begins.
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Indicates required field
Youth Name
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First
Last
Birth Date
*
Enter Birth Date
Age
*
Gender
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Male
Female
Male or Female?
Youth Email
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Parent / Legal Guardian
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First
Last
Guardian E-Mail
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Parent/Guardian Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
How do you plan to pay your registration fee?
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Mail in Cash or Check
Cash or Check at Camp Check-In
Are you bringing a first time friend?
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Yes
No
First Time Friends Name
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First
Last
If you are bringing a first time friend, please indicate their name. They must still complete their own registration.
2nd Emergency Contact
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2nd EC Relationship
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Emergency Contact Phone
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Will Student Be at Camp ALL 10 Days?
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YES
NO
If your student is not staying at camp for the entire 10 days, Please Select which Days You'll attend:
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Thurs- 7/20
Fri- 7/21
Sat - 7/22
Sun- 7/23
Mon- 7/24
Tue- 7/25
Wed- 7/26
Thurs- 7/27
Fri- 7/28
Sat- 7/29
Sun - 7/30
Check the box on the dates you plan to stay...
Request to serve on Tractor Crew? Must be fulltime 10 days, able to lift 30lbs+ and arrive on Monday before Camp.
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NO
YES
YOUTH COVENANT
As a participant in the Camp Sychar Youth Program, I agree to abide by the following expectations and guidelines:
I will be responsible for my actions and act in a Christian manner.
I will treat all people with respect. I will cause no injury or unhealthy criticism to others or myself.
I will treat other people’s property with respect and cause no form of vandalism or destruction to any private or Camp Sychar property.
I will not use alcohol, illegal drugs or tobacco. I agree to a NO SMOKING policy.
I will follow the dress code and dress appropriately to reflect Christian standards of modesty.
I will not leave the Camp Sychar grounds unless I have written permission.
I agree to the NO DRIVING and NO RIDING IN A CAR policy while at Camp.
I agree to work in harmony with the members of the group by following and participating in the scheduled meetings, activities, and cafeteria assignments.
I agree to listen to and adhere to the instructions given by the Youth Leaders.
WHILE IN THE YOUTH PROGRAM, I AGREE TO ABIDE BY THE POLICY of YOUTH MAY NOT GO INSIDE CABINS or ANY OTHER NON-YOUTH LODGING, INCLUDING LODGING BELONGING TO PARENTS or RELATIVES.
I have read all of the Information Sheets for Youth and agree to abide by them.
I agree to have a wonderful week of friends, fellowship, fun and growing in Jesus!!
I have read and fully intend to comply with the Youth Covenant as stated above:
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I DO NOT AGREE
I AGREE TO YOUTH COVENANT
You need to agree with the Youth Covenant to attend Camp Sychar Youth Program.
Student, Please Type Your Name as a Signature
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First
Last
SUPERVISED OFF CAMPUS GROUP ACTIVITIES PERMISSION FORM
I give permissions for my son / or daughter to participate in the following activities (Select ALL that apply):
I give permission to participate in Camp Sychar group recreation activities at the community park across the street
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YES
NO
I give permission to walk with Camp Sychar youth and staff to a Nursing Home or other nearby sites, to participate in a ministry outreach program.
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YES
NO
I give permission to participate in swimming and recreation activities at the Hiawatha Community Pool across the street with the Sychar youth
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YES
NO
If my youth is physically unable to walk to group activities, I give permission for them to ride in an automobile driven by a staff member, to and from these activities (no less than 3 people per car)
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YES
NO
Parent / Legal Guardian (Type Name to Sign)
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First
Last
Legal Guardian Activities Permission Date:
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PARENT AUTHORIZATION AND WAIVER
I give permission for my child to participate in the full range of activities and recreational events of Camp Sychar. I understand that a private car for transportation will be used only when physically necessary for a youth to be able to attend off-campus activities during camp, or in an emergency. Possible off-campus activities during camp, but not limited to the events listed, will be walking to a nearby nursing home or other site for an outreach program, and some recreational activities at the city park and swimming pool across the street from Camp Sychar.
I understand that all reasonable safety precautions will be taken by Camp Sychar and its employees and/or agents during camp activities. I further understand the possibility of unforeseen hazards and the inherent possibility of risks involved in the participation of my child in these activities. I agree to not hold Camp Sychar, its leaders, officers, employees, or voluntary staff liable for damages, losses, diseases, illnesses or injuries incurred by the youth subject of this form.
I understand that my child may be the subject of photographs or videos taken by the camp for publicity purposes and authorize the use of these photographs or videos.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
By clicking "I AGREE" and typing my name below, I understand that I am electronically signing for each signature in this application and it has the same legal effect and can be enforced the same as a written signature.
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I AGREE
I DO NOT AGREE
I have read all of the Parent & Youth Information Sheets, including the Housing Policy statement, and understand that while in the Youth Program youth are assigned living quarters in youth dormitories, and youth are not permitted inside cabins or any other non-youth lodging.
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YES
NO
Parent / Legal Guardian (Type in name as a legal signature)
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First
Last
This has the full force of a legal signature.
Legal Guardian Authorization and Waiver Date :
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CAMP SYCHAR NURSES INFORMATION
Name
*
First
Last
LIST ANY HEALTH CONDITIONS (IF NONE PLEASE STATE)
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ALLERGIES TO FOOD OR MEDICATION (IF NONE PLEASE STATE):
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Insurance Company
*
Policy #
*
DATE OF LAST TETANUS SHOT
*
Environmental Allergies (including insects) :
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If None, please type None.
Activity OR Dietary Restrictions/Allergies?
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Please be as descriptive as possible.
LIST ANY MEDICATION THAT SHOULD BE ADMINISTERED BY THE NURSE:
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If youth takes medications for sleep please keep in mind that the camp schedule can be very hard to keep up with if they are required to take these medications every night. Consider contacting youth’s family doctor to request a written order that these medications may be given as needed instead of every night during camp, it must be in writing.
Parent and youth must meet with camp nurse upon arrival IF any medication is required. If youth is on prescription medication, youth
MUST BE MATURE AND RESPONSIBLE FOR COMING TO THE CLINIC FOR REGULARLY SCHEDULED DOSES AS ORDERED BY PHYSICIAN.
Each medication
must
be in original labeled containers with name of youth and medication, dose, and times, and doctor's name.
If dose has been changed from label, youth must have statement from doctor.
The nurse is required to keep ALL medications secured. Youth may
NOT
keep any medications, even over the counter medications with them in the dorms.
PARENT MEDICAL AUTHORIZATION
I hereby authorize the Camp Sychar nurse or designated youth counselor to give over the counter medication (may be generic) to my child for minor illnesses as necessary, I have checked the medications below which my child MAY receive as needed:
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TYLENOL
MOTRIN
TUMS
COUGH DROPS
BENADRYL
PEPTO BISMOL
CALADRYL
IMODIUM
COLACE FORCONSTIPATION
HYDROCORTISONE CREAM
ALOE FOR BURNS
NEOSPORIN ORIMODIUM FOR BACTINE FOR CUTS
NONE OF THE ABOVE
I understand that in the event medical intervention is needed, every attempt will be made to contact me. If I cannot be reached in an emergency, I hereby authorize emergency medical treatment, injection, anesthesia, surgery, or dental care to be given to my son/daughter, as considered advisable or necessary in the judgment of an emergency medical professional or physician.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Camp Sychar through its accident policy will be used as secondary coverage.
By clicking "I AGREE" and typing my name below, I understand that I am electronically signing for each signature in this application and it has the same legal effect and can be enforced the same as a written signature
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I AGREE
LEGAL GUARDIAN ELECTRONIC SIGNATURE
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First
Last
DATE:
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Submit